Medicaid expansion linked to increased prescribing of buprenorphine for opioid use disorder treatment

March 16, 2017 – States where Medicaid coverage was expanded under the Affordable Care Act have had a significant increase in prescribing of buprenorphine — a medication that plays an important role in addressing the opioid epidemic, reports a study in the April issue of Medical Care. The journal is published by Wolters Kluwer.

"Our findings suggest that Medicaid expansion has the potential to reduce the financial barriers to buprenorphine utilization and improve access to medication-assisted treatment of opioid use disorder," write Hefei Wen, PhD, of University of Kentucky College of Public Health, Lexington, and colleagues. The study also highlights the need for adequate numbers of physicians approved to prescribe buprenorphine.

Increased Buprenorphine Prescribing in States with Medicaid Expansion

The researchers analyzed trends in Medicaid-covered prescriptions for buprenorphine in states that did and did not expand Medicaid coverage under the Affordable Care Act. Buprenorphine is an "opioid partial agonist" that is effective in reducing opioid use, promoting abstinence, and aiding recovery.

Twenty-six states (and the District of Columbia) implemented Medicaid expansion in 2014. These states showed "upward trends" in Medicaid-covered buprenorphine prescriptions after the expansions. In contrast, buprenorphine prescribing did not significantly increase in states that did not expand Medicaid or expanded it after 2014.

After adjustment for other factors, Medicaid expansion was associated with a 70 percent increase in buprenorphine prescriptions. The increased number of prescriptions was accompanied by a 50 percent increase in Medicaid spending on buprenorphine.

In addition to Medicaid coverage, the number of physicians approved to prescribe buprenorphine was also an important contributing factor in access to buprenorphine. Because buprenorphine is a controlled substance, there are strict federal regulations on the qualifications of the physicians who can prescribe it for patients with opioid use disorder and the number of patients they can treat.

For each ten percent increase in the number of physicians approved to treat up to 100 patients in a given year, there was a 45 percent increase in buprenorphine prescriptions and a 31 percent increase in buprenorphine spending associated with the increase in the number of approved physicians. In areas with fewer approved prescribers, Medicaid expansion had a limited impact on buprenorphine prescribing.

Buprenorphine–the most commonly prescribed medication for opioid use disorder–is an important part of strategies to combat the ongoing opioid epidemic in the United States. Lack of health insurance coverage has been a major barrier to buprenorphine treatment. Medicaid expansion has the potential to increase availability of medication-assisted treatment to low-income groups with disproportionately high rates of opioid use disorder.

The new study provides evidence of a substantial increase in buprenorphine prescribing in states that expanded Medicaid. Further improvement is expected as states implement additional measures to facilitate access to Medicaid coverage and medication-assisted treatment for low-income patients with opioid use disorders

Dr. Wen and colleagues also emphasize the importance of physician prescribing capacity–increasing access to health insurance seems to have a limited impact on buprenorphine use in areas where there are not enough approved prescribers. The authors conclude, "Sufficient physician prescribing capacity is necessary for ensuring that Medicaid expansion achieves its full potential in improving buprenorphine utilization."

###

Click here to read "Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment."

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.